title: Decision-making and accountability: differences of distribution.
abstract: The cognitive and individual framing of clinical decision-making has been undermined in the social sciences by attempts to reframe decision-making as being distributed. In various ways, shifts in understanding in social science research and theorising have wrested clinical decision-making away from the exclusive domain of medical practice and shared it throughout the healthcare disciplines. The temporality of decision-making has been stretched from discrete moments of cognition to being incrementally built over many instances of time and place, and the contributors towards decision-making have been expanded to include non-humans such as policies, guidelines and technologies. However, frameworks of accountability fail to recognise this distributedness and instead emphasise independence of thought and autonomy of action. In this article I illustrate this disparity by contrasting my ethnographic accounts of clinical practice with the professional codes of practice produced by the General Medical Council and the Nursing and Midwifery Council. I argue that a 'thicker' concept of accountability is needed; one that can accommodate the diffuseness of decision-making and the dependencies incurred in collaborative work.
authors.affiliation: Lancaster Medical School, Lancaster University.
authors.forename: Dawn
authors.initials: D
authors.lastname: Goodwin
mesh_terms: D000758:Anesthesia; D000884:Anthropology, Cultural; D003657:Decision Making; D004739:England; D006801:Humans; D017009:Professional Autonomy; D012941:Social Responsibility
keywords: accountability; autonomy; distributed decision-making; ethnography; professional codes of practice